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U.S.

Department of Housing and Urban Development


Office of Community Planning and Development

Homebuyer Set Up and Completion Form


HOME Program (For single and multi-address activities)
Check the appropriate box:
Original Submission
Ownership Transfer

Name and Phone Number of Person Completing Form:


Change Owners Address
Revision

Set Up Activity:
A. General Information.
1. Name of Participant:

2. IDIS Activity ID Number:

3. Activity Name:

B. CHDO Questions.

(Only if applicable)
1. Is funding limited to CHDO Operating (CO) or CHDO
Capacity Building (CC) (Y/N)?: (If Yes, STOP. DO
NOT FILL OUT THIS FORM.)

2. Will activity be funded with CR (Y/N)


If yes, CHCO Acting as (enter code) __________
(1) Owner
(2) Sponsor
(3) Developer
4. Is the activity going forward? (Y/N):

3. Will initial funding be a CHDO Site Control and/or


Seed Money Loan (Y/N)? (Y/N) _________

(If Y, fill out the rest of the form. If N, only the cost information is needed.)

(If Y, answer Item 4.)

C. Objective and Outcome.


1. Objective (enter code): ___________
(1) Create suitable living environment
(2) Provide decent affordable housing
(3) Create economic opportunities

2. Outcome (enter code): ___________


(1) Availability/accessibility
(2) Affordability
(3) Sustainability

D. Special Characteristics.
1. Activity Location
Type Y next to any that apply
(1)____CDBG Strategy Area
(2)____Local target area
(3)____Presidentially declared major disaster area
(4)____Historic preservation area

(5) ___ Brownfield redevelopment area


(6) ___ Conversion of nonresidential to
residential use
(7) ___Colonia (For AZ, CA, NM, TX)

2. Will this activity be carried out


by a faith-based organization
(Y/N)?

E. Activity Information.
1. Activity Type (enter code):
(2) New Construction Only
(3) Acquisition Only

(4) Acquisition & Rehab


(5) Acquisition & New Construction

2. Homebuyers Name (optional):


4. City:

5. State:

10. Multi-Address (Y/N)?

F. Developer.

3. Street:
6. Zip Code:

7. County code:

Activity Estimates:
8. HOME Units:

11. Loan Guarantee (Y/N)?

(For multi-address activities only)

1. Developer Type (Enter code):

2. Developers Name:

(1) Individual
(2) Partnership
(3) Corporation

3. Developers Street Address:

(4) Not-for-Profit
(5) Publicly Owned
(6) Other

4. City:

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9. HOME Cost:

5. State:

6. Zip Code:

Revised (8/06)

Complete Homebuyer Activity:


G. Activity Information. If this is a multi-address activity, make copies of this form so that cost and beneficiary information
is reported for each address - Sections I, J, and K.

1. Activity Type (enter code):


(2) New Construction Only
(3) Acquisition Only
(4) Acquisition & Rehab
(5) Acquisition & New Construction

2. Property Type (enter code):


(1) 1-4 Single Family
(2) Condominium
(3) Cooperative
(4) Manufactured Home

4. Lease Purchase? If yes, date of agreement


(For single address activities.)

3. FHA Insured (Y/N)?


(For single address activities.)

(5) Completed Units:


Total number:

HOME-assisted :

H. Units.
1. Of the Completed Units, the number:

Total

HOME-assisted

Meeting Energy Star standards:


504-accessible:

2. Period of Affordability: If you are imposing a period of affordability that is longer than the regulatory minimum, enter the total years
(HOME minimum + additional) of affordability.
years.
PJ-imposed period of affordability:

I. Property Address. (For multi-address activities.)


1. Homebuyers Name (optional):
3. City:

2. Homebuyers Street Address:


4. State:

5. Zip Code:

6. County:

J. Costs.
Purchase Price:
Value After Rehab (for Acquisition/Rehab activities only):
1.

HOME Funds (Including Program Income)


a. Property Costs
(1) Amortized Loan
(2) Grant
(3) Deferred Payment Loan (DPL)
(4) Other

Totals
$
$
$
$

b. Downpayment Assistance
(1) Amortized Loan
(2) Grant
(3) Deferred Payment Loan (DPL)
(4) Other

$
$
$
$

$
$

c. CHDO Loan
HOME Total this address [a + b + c]

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Revised (8/06)

2. Public Funds
(1) Other Federal Funds

(2) State/Local Funds

(3) Tax Exempt Bond Proceeds

Total Public Funds [(1) + (2) + (3)]

3. Private Funds
(1) Private Loans

(2) Owner Cash Contribution

(3) Private Grants

Total Private Funds [(1) + (2) + (3)]

4. Activity Total (or Total this address)

K. Household Characteristics.

(Refer to code below where applicable)


Household

Unit #

# of Bdrms

Occup
ant

% Med

Hispanic?
Y/N

Race

Size

Type

Assistance
Type

Total Monthly
Rent

N/A

1. Homebuyer Counseling
Homebuyer received (enter code):
(1) No Counseling
(3) Post-counseling
(2) Pre-counseling
(4) Both

2. FHA Insured Y/N?


(For multi address activities.)

3. First-time homebuyer Y/N?

4. Coming from subsidized housing Y/N?

5. Lease Purchase Y/N?


(For multi address activities.)

If yes, date of agreement:

# of Bdrms
0 SRO/Efficiency
1 1 bedroom
2 2 bedrooms
3 3 bedrooms
4 4 bedrooms
5 5 or more bedrooms

Assistance Type
1 Section 8
2 HOME TBRA
3 Other federal, state
or local assistance
4 No assistance

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Occupant
1 Tenant
2 Owner
9 Vacant Unit

Household Size
1 1 person
2 2 persons
3 3 persons
4 4 persons
5 5 persons
6 6 persons
7 7 persons
8 8 or more persons

Household % of Med
1 0 to 30%
2 30+ to 50%
3 50+ to 60%
4 60+ to 80%

Household Type
1 Single, non-elderly
2 Elderly
3 Single parent
4 Two parents
5 Other

Household Race
11 White
12 Black or African American
13 Asian
14 American Indian or Alaska Native
15 Native Hawaiian or Other Pacific Islander
16 American Indian or Alaska Native & White
17 Asian & White
18 Black or African American & White
19 American Indian or Alaska Native & Black or African American
20 Other Multi Racial

Revised (8/06)

Instructions for Completing the Homebuyer Set-up and Completion Report


HOME Program
Read the instructions for each item carefully before completing the
form. The purpose of this report is to assist with the collection of
information to be entered into IDIS.

(1)

Applicability. This report is to be completed for each homebuyer


activity assisted with HOME funds.
Timing. This report form is used to setup an activity in IDIS so that
funds may be drawn down and to complete the activity so that the
HOME Program reporting requirements are met.
Set Up Activity
A. General Information. (Only applicable if the activity is being
carried out by a CHDO.)
1. Name of Participant. Enter the name of the participating
jurisdiction or the agency administering the homebuyer activity.
2. IDIS Activity ID Number. Enter the activity number assigned by
IDIS.
3. Activity Name. Enter the name that the grantee or sub-grantee
has designated to the activity.
B. CHDO Questions. (Only applicable if the activity is being carried
out by a CHDO.)
1. Is funding limited to CHDO Operating (CO) or CHDO capacity
Building (CC)? This report does not apply to CO or CC
activities. In IDIS, fund and draw after selecting CO/CC on the
HOME menu.
2. Will the activity be funded with CR (Y/N)? ______ If yes,
CHDO Acting as: (Enter code) ______
(1) Owner
(2) Sponsor
(3) Developer
3. Will initial funding be a CHDO Site Control and/or Seed
Money Loan (Y/N)? _____ (If Y, answer 4)
4. Is the activity going forward? After funding and drawing CL,
answer Y to proceed to set up a Homebuyer activity or N to
report costs and complete the activity.
C. Objective and Outcome
Objective. Enter the code of the objective that best describes the
purpose of the activity. If a code is not entered in IDIS, the system will
default the answer to 2 Decent affordable housing.
1. Suitable living environments. Applies to activities that benefit
communities, families, or individuals by addressing issues in their
living environment.
2. Decent affordable housing. Applies to housing activities that
meet individual family or community needs. This objective should
not be used for activities where housing is an element of a larger
effort.
3. Creating economic opportunities. Applies to activities related
to economic development, commercial revitalization, and job
creation.
Outcome. Enter code of the outcome that best describes the benefits
resulting from the activity. If a code is not entered in IDIS, the system
will default the answer to 2 Affordability.
1.

2.

3.

Availability/accessibility. Applies to activities that make


services, infrastructure, housing, and shelter available and
accessible. Note that accessibility does not refer only to physical
barriers.
Affordability. Applies to activities that provide affordability in a
variety of ways. It can include the creation or maintenance of
affordable housing, basic infrastructure hookups, or services such
as transportation or day care.
Sustainability. Applies to activities that promote livable or viable
communities and neighborhoods by providing services or by
removing slums or blighted areas.

D. Special Characteristics
1. Activity Location. Type Y next to any that apply. IDIS will
default the answer to N if an answer is not typed in the field.

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2.

CDBG strategy area is defined as HUD-approved


neighborhood or Community Revitalization strategy Area
(NRSA or CRSA), identified in the grantees
Consolidated/Annual Action Plan under Section 91.215(e) or
Section 91.315(e)(2).
(2) Local target area is defined as a locally designated nonCDBG strategy area targeted for assistance.
(3) Presidentially declared major strategy area is defined as an
area declared a major disaster under subchapter IV of the
Robert T. Stafford Disaster Relief and Emergency
Assistance Act.
(4) Historic Preservation Area is defined as an area designated
for historic preservation by local, state, or federal officials.
(5) Brownfield redevelopment area is defined as an abandoned,
idle, or underused property where expansion or
redevelopment is complicated by real or potential
environmental contamination.
(6) Conversion from non-residential or residential use is self
explanatory. An example is converting an old warehouse
into rental units or condominiums.
(7) Colonia is defined as a rural community or neighborhood
located within 150 miles of the U.S.-Mexican border that
lacks adequate infrastructure and frequently also lacks other
basic services. This field only applies to activities located in
the states of Arizona, California, New Mexico, and Texas.
Faith-Based Organization. Will this activity be carried out by a
faith-based organization (Y/N)? Enter Y if it is known or if the
organization declares itself to be a faith-based organization. If
not, enter N. Note: IDIS will enter the default answer of N if an
answer is not typed in the field.

E. Activity Information
1. Activity Type. (Enter code): to indicate the type of activity.
(1) New Construction Only.
Any activity that involved: (a) the addition of units outside the
existing walls of the structure and (b) the construction of a
new residential unit(s).
(2) Acquisition Only.
Acquisition of a structure that received certificate of
occupancy at least 13 months before acquisition, which did
not require rehabilitation and which is being used to provide
affordable housing.
(3) Acquisition & Rehab.
A HOME-assisted rehabilitation activity, which included the
acquisition of real property.
(4) Acquisition & New Construction.
A HOME-assisted new construction activity, which included
the acquisition of real property. This includes acquisition of
a structure that has received an initial certificate of
occupancy within a one-year period prior to acquisition.
2. Homebuyers Name (optional). Enter the name of homeowner.
For multi address activities the name of the development can be
entered.
3. Street. Self explanatory. For multi address activities enter a
general description of the project location.
4. City. Self explanatory.
5. State. Self explanatory.
6. Zip code. Self explanatory.
7. County code. Enter the county name or code.
8. Activity Estimates. HOME Units. Enter the estimated total
number of units (upon completion) that will receive HOME
assistance.
9. Activity Estimated HOME Cost. Enter the total amount of
HOME funds requested for the activity.
10. Multi-Address (Y/N)? If the activity consists of more than one
home, enter Y so that costs and beneficiary information can be
reported for each address at completion.
11. Loan Guarantee? Y/N. Enter Yes or No to indicate whether this
activity is supported by a loan guarantee.
F. Developer Information. (For multi-address activities only.)
1. Developer Type. (Enter code.)
(1) Individual
(2) Partnership
Revised (8/06)

2.
3.

(3) Corporation
(4) Not-for-Profit
(5) Publicly Owned
(6) Other
Developers Name. Enter the name of the developer.
- 6. Developers Street Address, City, State, and Zip Code.
Self-explanatory.

Complete Homebuyer Activity


G. Activity Information
1. Activity Type. Only if the activity type has changed from set up
in E. 1, enter the revised completion activity type in the box.
2. Property Type. Enter code to indicate the type of property
assisted:
(1) 1-4 Single Family
(2) Condominium
(3) Cooperative
(4) Manufactured Home
3. FHA Insured (Y/N ) ? (For single address activities.) Enter Y for
yes or N for no to indicate whether the propertys mortgage is
insured by FHA.
4. Lease Purchase? (For single address activities.) If there is a
lease purchase agreement, enter the date of the agreement.
5. Completed Units: Total Number: HOME Assisted: Enter the
total number of completed units and the total number of HOME
Assisted units.

permanent financing, do not report both. Report all HOME funds


expended on the activity. (Note: Federal regulations specifically
prohibit paying back HOME funds with HOME funds.) For funds
other than HOME, to the extent a choice must be made to avoid
double counting, report permanent financing rather than construction
financing. The total amount of HOME funds reported in the block titled
Total HOME funds (Total Item (1) for all addresses must equal the
total amount disbursed through IDIS for this activity.
1.

H. Units
1. Of the units completed, the number: Total and HomeAssisted Meeting Energy Star Standards. Enter the total
number of completed units that meet Energy Star standards and
the number of completed HOME-Assisted units that meet Energy
Star standards.
Energy Star applies to substantial rehabilitation. It is a system for
achieving and verifying a level of building performance with
respect to energy efficiency. The performance level is certified by
third party contractors. See www.energystar.gov for more
information.
Total and HOME Assisted 504 accessible. Enter the total
number of completed units and completed HOME assisted units
that are 504 accessible. Note: IDIS will default the answers to
zero if units are not entered in these fields.
2.

Period of Affordability. If you are imposing a period of


affordability that is longer than the regulatory minimum, enter the
total years (HOME minimum + additional) of affordability. PJimposed period of affordability: ______ years. The period of
affordability for Homebuyer activities is based on the amount of
HOME funds invested in the housing:

2.

3.

Per Unit HOME Amount


Minimum Period of Affordability
----------------------------------------------------------------------------------Under $15,000
5 years
$15,000 to $40,000
10 years
Over $40,000
15 years
To indicate that the housing is to be affordable in perpetuity, enter
99 in the PJ-Imposed Period of Affordability field.
I. Property Address (For multi-address activities.)
1. Homebuyers Name. (Optional.)
2. - 6. Hombuyers Street Address, City, State, Zip Code, and
County Code. Self-explanatory.

4.

HOME Funds. (Including Program Income.)


Enter funds provided for a. Property Costs and for b.
Downpayment Assistance. Note: For this activity to be
reported as an ADDI activity, an amount must be entered in the
Downpayment Assistance Section b. for each property address
that is to be counted as assisted with ADDI funds.
a. Property Costs - b. Downpayment Assistance
(1) Amortized Loan. Enter the amount of HOME funds
provided for this activity in the form of an amortized loan. If
there are multiple loans, enter the interest rate and term of
the largest loan.
(2) Grant. Enter the amount of HOME funds provided without
any repayment requirements. (Note: A grant may be used
to reduce the principal amount borrowed, a principal
reduction payment, or the effective interest rate, an interest
subsidy payment, on a privately originated loan.)
(3) Deferred Payment Loan (DPL). Enter the amount of
HOME funds provided through loans where payment of
principal and interest is deferred until a future time and enter
the interest rate and amortization period, if any. A DPL is
sometimes called a conditional grant (e.g., repayment is
required when the property is sold, or is forgiven if the owner
does not sell the property for a specified number of years or
repayment of principal and interest starts after the bank loan
is repaid.)
(4) Other. Enter the total amount of HOME funds provided for
subsidy funding that is other than the type of loan/grant
assistance identified in the above items listed in (1) through
(3).
c. CHDO Loan. Enter the amount of HOME funds provided as
a CHDO loan for the activity.
Total HOME Funds or total this address. Enter the total of
items a through c as the amount of HOME funds expended.
Public Funds.
(1) Other Federal Funds. Exclude any HOME funds
expended.
(2) State/Local Funds.
(3) Tax Exempt Bond Proceeds. Report funds used for
development costs only.
Total Public Funds. Enter the total of items (1) through (3) as
the amount of Public Funds expended.
Private Funds.
(1) Private Loans. Enter the amount of all of the costs that
have been paid with funds obtained from private financial
institutions, such as banks, savings and loans, and credit
unions, and enter the interest rate and amortization period of
the loan. If there are multiple loans, enter the interest rate
and term of the largest loan. (Do not double count.)
(2) Owner Cash Contribution. Enter the amount of all cash
contributions provided by the homebuyer.
(3) Private Grants. Enter the amount of cash contributions
provided by private organizations, foundations, donors, etc.
Total Private Funds. Enter the total of items (1) through (3) as
the amount of Private Funds expended.
Activity Total or Total Address. Enter the sum of totals for
HOME funds, Public funds and Private funds.

J. Costs
Purchase Price. Enter the price paid by the homebuyer for the
property as evidenced on the deed.

K. Household Characteristics.
Complete one line for the head of household of each residential unit
that is receiving homebuyer assistance from the HOME Program.

Value After Rehab. Enter the dollar value of the property. The dollar
value is the appraised value of the property before rehabilitation plus
the total rehabilitation cost (i.e. all materials, supplies and labor costs
directly related to the rehabilitation of the property).

Unit Number. Enter the unit number of each unit that will receive
HOME assistance.

Costs. Include all HOME funds used for the activity and all other
funds (public and private). Do not double count. If private funds are
used for construction financing and those funds are later replaced by
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Number of Bedrooms. Enter 0 for a single room occupancy (SRO)


unit or for an efficiency unit, 1 for 1 bedroom, 2 for 2 bedrooms, 3 for 3
bedrooms, 4 for 4 bedrooms, and 5 for 5 or more bedrooms.

Revised (8/06)

Occupant. For homebuyer activities, one unit must be owner


occupied. If there are tenant occupied units, enter 1 for tenant or 9 for
vacant.
Percent of Area Median Income. For each occupied residential unit,
enter one code only based on the following definitions:
1. 030 Percent of Area Median Income refers to a household
whose annual income is at or below 30 percent of the median
family income for the area, as determined by HUD with
adjustments for smaller and larger families.
2. 30+50 Percent of Area Median Income refers to a household
whose annual income exceeds 30 percent and does not exceed
50 percent of the median family income for the area, as
determined by HUD with adjustments for smaller and larger
families.
3. 50+60 Percent of Area Median Income refers to a household
whose annual income exceeds 50 percent and does not exceed
60 percent of the median family income for the area, as
determined by HUD with adjustments for smaller and larger
families.
4. 60+80 Percent of Area Median Income refers to a household
whose annual income exceeds 60 percent and does not exceed
80 percent of the median family income for the area, as
determined by HUD with adjustments for smaller and larger
families.
Hispanic? Y/N. For each occupied residential unit, enter the ethnicity
for the head of household as either Y for Hispanic or Latino or N if
the head of household is not Hispanic nor Latino. Hispanic or Latino
race is defined as a person of Cuban, Mexican, Puerto Rican, South or
Central American, other Spanish culture or origin, regardless of race.
The term, Spanish origin, can be used in addition to Hispanic or
Latino.

5.

Other. Any household not included in the above 4 definitions,


including two or more unrelated individuals.

Assistance Type. For rented units, enter one code only to indicate
the type of assistance, if any, being provided to the tenant.
1. Section 8. Tenants receiving Section 8 assistance through the
Section 8 Certificate Program under 24 CFR part 882 or the
Section 8 Housing Voucher Program under 24 CFR part 887.
2. HOME TBRA. Tenants receiving HOME tenant-based rental
assistance.
3. Other federal, state or local assistance. Tenants receiving
rental assistance through other federal, state or local rental
assistance programs.
4. No assistance. Self-explanatory.
Total Rent. For renters, enter the total monthly rent (tenant
contribution plus subsidy amount).
1. Homebuyer Counseling. Enter the code to indicate the type of
counseling received by the homebuyer, if any:
(1) No counseling
(2) Pre-counseling
(3) Post-counseling
(4) Both
2. FHA-Insured (Y/N)? Enter Yes, Y, or No, N, to indicate
whether the propertys mortgage is insured by FHA.
3. First-time Homebuyer (Y/N)? Enter Y, if a first-time
homebuyer. If not, enter N.
4. Coming from subsidized housing Y/N? Enter Y if the
homebuyer was living in public housing or receiving rental
assistance from a federal, state or local program immediately
prior to HOME assistance or N if not.
5. Lease Purchase (Y/N)?: (For single address activities.) If there
is a lease purchase agreement, enter the date of the agreement.

Race of Head of Household. For each occupied residential unit,


enter one code only based on the following definitions:
11. White. A person having origins in any of the original peoples of
Europe, North Africa or the Middle East.
12. Black/African American. A person having origins in any of the
black racial groups of Africa. Terms such as Haitian or Negro
can be used in addition to Black or African American.
13. Asian. A person having origins in any of the original peoples of
the Far East, Southeast Asia, or the Indian subcontinent
including, for example, Cambodia, China, India, Japan, Korea,
Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
14. American Indian/Alaska Native. A person having origins in any
of the original peoples of North and South America (including
Central America), and who maintains affiliation or community
attachment.
15. Native Hawaiian/Other Pacific Islander. A person having
origins in any of the original people of Hawaii, Guam, Samoa or
other Pacific Islands.
16. American Indian/Alaska Native & White. A person having
these multiple race heritages as defined above.
17. Asian & White. A person having these multiple race heritages as
defined above.
18. Black/African American & White. A person having these
multiple race heritages as defined above.
19. American Indian/Alaska Native & Black/African American. A
person having these multiple race heritages as defined above.
20. Other Multi Racial. For reporting individual responses that are
not included in any of the other categories listed above.
Household Size. Enter the appropriate number of persons in the
household: 1, 2, 3, 4, 5, 6, 7, or 8 or more persons (for households of
more than 8, enter 8).
Household Type. For each residential unit, enter one code only
based on the following definitions:
1. Single, Non-elderly. One-person household in which the person
is not elderly.
2. Elderly. One or two person household with a person at least 62
years of age.
3. Single Parent. A single parent household with a dependent child
or children (18 years old or younger).
4. Two Parents. A two-parent household with a dependent child or
children (18 years old or younger).

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Revised (8/06)